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Boys three times more likely to have growth delay with Crohn's

The largest study ever conducted of the effect of gender in children with Crohn’s Disease, a chronic intestinal disorder, has found that boys were over three times more likely than girls to suffer one of the condition’s most devastating effects: the failure to grow normally. That is surprising, researchers said, because the study also found girls had a more severe disease course than boys.

“We expected to see more growth failure along with the more severe disease course, so this finding was surprising and counterintuitive,” said lead study researcher Neera Gupta, MD, of UCSF Children’s Hospital. “There is a social stigma to growth failure. Being small can be really devastating to the children because they can look a lot younger than their same-aged peers.”

Crohn’s is one of the most common forms of inflammatory bowel disease. About one quarter of the more than one million Americans with Crohn’s first exhibit symptoms in childhood. Crohn’s is often first diagnosed in children because of an inability to grow normally. Up to a third of children with Crohn’s have growth failure.

The retrospective study of nearly 1,000 children with Crohn’s appears online in the December issue of the journal Pediatrics. It compares the presentation and course of Crohn’s among boys and girls enrolled in the national Pediatric Inflammatory Bowel Disease (PediIBD) Consortium Registry between 2000 and 2003. Children in the study ranged from infants to 18 year olds, though most were age six or older. More than half, 57 percent, were male.

The researchers examined a variety of factors, including the location of disease in the bowel, symptoms at onset of the disease, medications prescribed and complications including growth failure for boys and girls. Children with Crohn’s don’t grow properly, in part because they eat less because of pain and cannot absorb nutrients well because of intestinal inflammation. Another cause of growth delay is the corticosteroid drugs used to treat inflammation.

Thirteen percent of males in the study experienced growth failure, while only 4 percent of girls were affected at 10 years from the time of initial diagnosis, Gupta said. “Children can have the appearance of being in middle school when they’re actually in high school,” she said.

Crohn’s is a chronic, auto-immune disease whose cause is not well understood but probably has a genetic component. Primary symptoms include stomach pain, fever, diarrhea and poor growth. Crohn’s sufferers can also have certain types of skin rashes, liver problems, eye inflammation and arthritis due to intestinal inflammation.

Girls in the study were nearly three times more likely than boys to suffer from two characteristic skin conditions, erythema nodosum and pyoderma gangrenosum, which are painful types of sometimes ulcerous skin conditions. The mouth sores that are seen in Crohn’s were also more frequent in girls than boys. The researchers also found in an earlier study that girls were more likely than boys to require resection, or removal, of part of the small bowel or colon to treat the condition.

“It’s the combination of these findings that suggest that girls’ disease course is more severe than that of boys,” Gupta said.

Gupta said the PediIBD Consortium researchers are now examining the reasons for differences in growth delay in boys and girls with Crohn’s, focusing on the interplay between inflammation, the sex hormones and growth hormones.

“The most important thing about this research is that, if we can understand the underlying mechanism that is creating these differences, it can lead to future medical treatments that would improve management of growth delay in Crohn’s Disease, so that all children would reach their genetic potential for growth,” Gupta said.

Other study researchers include Melvin Heyman, MD, of UCSF Children’s Hospital; Alan Bostrom, PhD, of the UCSF Department of Epidemiology and Biostatistics; Barbara Kirschner, MD, of the University of Chicago Comer Children’s Hospital; George Ferry, MD, and Terry Smith, MS, of Texas Children’s Hospital; Harland Winter, MD, of Massachusetts General Hospital for Children; Robert Baldassano, MD, of the Children’s Hospital of Philadelphia; Benjamin Gold, MD, of Emory University School of Medicine; Oren Abramson, MD, of Kaiser Permanente of Northern California; and Stanley Cohen, MD, of the Children’s Center for Digestive Healthcare, Children’s Healthcare of Atlanta.

Funding for the study was provided by the National Institutes of Health, the Children’s Digestive Health and Nutrition Foundation and the Crohn’s and Colitis Foundation of America. Individuals with a child with Crohn’s who would like to participate in research studies may contact the UCSF Pediatric IBD Program at (415) 514-4423.

One of the nation’s top children’s hospitals, UCSF Children’s Hospital creates an environment where children and their families find compassionate care at the healing edge of scientific discovery, with more than 150 experts in 50 medical specialties serving patients throughout Northern California and beyond. The hospital admits about 5,000 children each year, including 1,600 babies born there.